1851393086 NPI number — DR. AHMAD A AMIR M.D.

Table of content: DR. AHMAD A AMIR M.D. (NPI 1851393086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851393086 NPI number — DR. AHMAD A AMIR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMIR
Provider First Name:
AHMAD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851393086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3855 BROAD STREET
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-545-7881
Provider Business Mailing Address Fax Number:
805-548-8785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
816 E ENOS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-7295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-346-1717
Provider Business Practice Location Address Fax Number:
805-346-1525
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G84926 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20155344 93401 A001 . This is a "TRICARE GRP PIN - SLO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ65444Z . This is a "BLUE SHIELD TMPLTN GP PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0099341 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ09808Z . This is a "BLUE SHIELD SLO GRP PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ09809Z . This is a "BLUE SHIELD AG GRP PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 201555344 93420 A001 . This is a "TRICARE GRP PIN - AG" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G84926 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0099340 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0099343 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00213688 . This is a "INDIV RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ09810Z . This is a "BLUE SHIELD SM GRP PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1117 . This is a "CMSP GRP PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 201555344 93454 A001 . This is a "TRICARE GROUP PIN - SM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0099342 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G849260 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC7249 . This is a "RR MEDICARE GRP PIN" identifier . This identifiers is of the category "OTHER".




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